Provider Demographics
NPI:1225231566
Name:PHAM, ANTHONY NHUT (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:NHUT
Last Name:PHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12661 SE POWELL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3400
Mailing Address - Country:US
Mailing Address - Phone:503-801-8888
Mailing Address - Fax:503-477-9805
Practice Address - Street 1:3851 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4803
Practice Address - Country:US
Practice Address - Phone:503-463-6131
Practice Address - Fax:503-463-6138
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR713737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor